我国视损伤残疾评定标准问题研究

视损伤评价是制定视损伤残疾标准、统一标准适用的基础。由于基本问题缺乏界定与研究,导致我国残疾标准制定困难、理解适用混乱,影响了鉴定意见的科学性。应解决视功能含义、确定视残疾与个体残疾的关系、拣选检验指标、开展视残疾生存质量调查和一体评价视损伤等主要问题,加强残疾理论与法学、临床医学等其他学科的交叉研究,建立适合我国社会发展需求的残疾评价体系,促进残疾评定的科学化和标准化。     

肩关节损伤致肢体功能障碍程度评价方法比较

目的探讨能客观反映肩关节功能障碍对肢体功能影响的评价方法。方法通过用我国《道路交通事故受伤人员伤残评定》（简称＂《道标》＂）的权重指数法与美国《永久残损评定指南》（Guides to the Evaluation of Permanent Impairment,GEPI）（简称GEPI法）,对133例肩关节损伤后伤残评定案例进行回顾性评价;并用两种评价方法对肩关节不同运动方向及不同活动度对上肢功能影响进行全方位的比较。结果 133例肩关节功能障碍案例,权重指数法达到伤残的总比例高于GEPI法;但在功能丧失不同比例段两者有差异。差异的原因在于,在GEPI法中,肩关节不同运动方向所占的权重不同,前屈上举与外展上举对于肩关节功能相对重要,并考虑关节功能位对肢体障碍程度的影响;而权重指数法,上肢功能的关系与关节活动度呈简单的线性关系,与关节活动方向及功能位无关。结论 GEPI法比权重指数法能更能客观地反映肩关节功能障碍对肢体功能丧失的影响程度。     

Limitation of medical research in German law.

In Germany, pharmaceutical trials and the testing of medical devices is regulated by statute. Any other kind of medical experimentation is handled according to the Declaration of Helsinki. Medical experimentation has to be reviewed by an ethics committee before the start and there has to be an elaborate research protocol, which provides for the protection of the experimental subject. In case of an accident, there is compulsory accident insurance as far as pharmaceutical trials and the testing of medical devices are concerned. The third party accident insurance just covers material loss, there is no provision paying and suffering. The sum paid by the insurance company is set off against damages for negligence. There is no strict liability for medical experimentation, but the German courts are expected to set very high standards for medical care in experimentation. The data protection and medical confidentiality have been lessened because of the European law that requires the experimental subject to give his consent to the inspection of the data or the file and if he takes part in the experimentation, that his data and some of his cells might be with the pharmaceutical company forever. In general, the German law seems to be adequate to the protection of experimental subjects.     

《损伤程度》与《致残分级》关于脊柱四肢评定条款的比较

本文对《人体损伤程度鉴定标准》和《人体损伤致残程度分级》有关脊柱四肢评定方面的条款进行比较研究。从结构破坏、功能障碍、结构破坏合并功能障碍等方面分析两者的异同,为损伤程度和致残程度评定提供借鉴。     

颅脑损伤患者智能和记忆损害的相关因素研究

目的探讨交通事故所致颅脑损伤伤者的智能和记忆损害及相关因素。方法 统计分析成都市1999年1月1日至2001年12月31日间因交通事故造成颅脑损伤的652例伤者的心理测验、脑电图及脑影像学资料。结果研究组平均智商为77.85±15.97,27.9％的伤者智商低于70;51.9％的记忆商低于51。智力损害与文化程度、左颞叶损伤、≥3个脑叶损伤以及脑电图异常明显相关;记忆损害与文化程度、损伤和鉴定检查的间隔时间、脑于损伤、左颞叶损伤、脑电图异常明显相关。结论交通事故造成颅脑损伤的伤者多有不同程度的智力和记忆损害,且与左颞叶损伤、脑电图异常、文化程度、脑干损伤等因素有关。     

Severity of vehicle bumper location in vehicle-to-pedestrian impact accidents

Pedestrian protection is one of the key topics for safety measures in traffic accidents all over the world. To analyze the relation between the collision site of the vehicle bumper and the severity of the lower extremity injuries, we performed biomechanical experiments. We compared the applied external force and the risks of subsequent injuries between the impact of the center and side positions of the front bumper. These comparisons were performed by practical impact tests with eight typical different types of cars which were typical of the current vehicle fleets. The tests were made using the TRL legform impactor which was a mechanical substitute of a pedestrian lower extremity. The TRL impactor is used all over the world for assessing the safety of car bumpers. It was found that the risks of lower extremity injuries in the impacts at the side positions, in front of the vehicle's side member, were significantly higher than those at the center. In the tests, we found that foam materials around the rigid front cross member had a significant effect on reducing the lower extremity injury risks and especially tibia fracture risk against vehicle bumper center collisions, but had little effect at the sides of the bumper over the vehicle's side members where the foam was thinner. We also found that the front shape of the vehicle affected the risk of ligaments injuries. According to these results, the information of impact locations of cars in vehicle-to-pedestrian traffic accidents is valuable for clinicians to diagnose patients with lower extremity injuries in traffic accidents and for forensic pathologists to analyze the accident reconstruction. Furthermore, the results suggest that testing of the bumper area in front of the main longitudinal beams should be included in the car safety legislation to require pedestrian safety.     

道路交通事故轻度精神伤残者智能损害评定

目的探索道路交通事故轻度精神伤残者智能损害评定方法和价值。方法通过分析智商测定在轻度精神伤残者评定中的运用,探索智商测定在轻度精神伤残者智能损害评定中的运用价值。结果不同性质颅脑损伤组间不同智能损害程度构成比有统计学差异（P〈0.05）;量表智商与颅脑损伤性质有关（P〈0.05）,除继发全面性与继发局部性损害（P〈0.05）、继发局部性与混合性损害之间（P〈0.01）有统计学差异外,其余各组两两之间均无统计学差异;不同颅脑损伤程度组间不同智能损害程度构成比无统计学差异;量表智商与颅脑损伤程度呈负相关（P〈0.01）,除中型与重型损伤之间无统计学差异外,其余各组两两之间均具有统计学差异;智能损害程度、量表智商均与精神伤残等级呈正相关（P〈0.01）;量表智商并非评价智能损害的唯一指标,智能损害也并非精神伤残唯一的构成因素。结论智商测定对评价智能损害与精神伤残具有一定参考价值,精神伤残评定需根据颅脑损伤性质与程度、智能损害或精神障碍程度以及生活、社会功能状况综合评定。     

法学研究如何学术——学术史方法的重申

当下中国法学研究学术性不强的原因主要在于法学研究者自身,因此需要将视线转向学术本身。基于学术史方法是学术最基本方法的判断,可以发现中国法学研究学术性不强的原因在于学术史方法的缺失,这使得中国法学研究中的学术性与非学术性混淆不清;法学难以确立自己学科的独立地位;法学研究中引证混乱并难以发挥学术评价功能;法学研究中学术传统西化倾向严重。而当代中国法学研究学术性完善之路在于:实用标准与学术标准的适度分离,确立学术的独立性与学术评价的独立标准;增强对学术重要性的认识;加强学术史意识,强化学术规范;自觉推动法学学术传统的中国化。学术性、学术史方法并不是我们对法学研究的更高要求,而只是提醒我们在法学研究中首先要回到学术研究的基本方法然后再谈其他方法。     

Survey of methods for the rating of psychiatric impairment in Australia

One of the enduring clinical issues in the assessment of plaintiffs in personal injury and workers' compensation claims, as well as applicants for social security and disablement benefits, is that of the evaluation of impairment and work incapacity. Many writers on this topic confuse the concepts of impairment and disability, and similar confusion is reflected in a number of the rating methods that purport to evaluate impairment but in reality assess disability. In Australia there are 20 distinct statutory schemes for workers' compensation, motor accident compensation, and social security and other benefits, which utilise a variety of methods for the rating of psychiatric impairment. Recent legislative changes designed to restrict access to personal injury compensation at common law, which in two Australian State jurisdictions require the use of impairment rating scales, also specify the rating methods to be used in the assessment of psychiatric impairment. This article discusses the concepts of impairment and disability as defined by the World Health Organisation, and reviews the various methods for the rating of psychiatric impairment that are specified by statute in the federal and State jurisdictions in Australia.     

“一体四层”的犯罪论体系之提倡——以大陆法系与我国犯罪论体系为分析对象

自然主义的犯罪论体系是既无评价对象又无评价标准的“无体无层”的体系,存在论的犯罪论体系是评价对象与评价标准不分的“体、层不分”的体系,规范论的犯罪论体系是只有评价标准没有评价对象的“有层无体”的犯罪论体系,组合式的犯罪论体系是“体、层矛盾”的犯罪论体系,诸种体系皆为不当。事实与价值绝对二分论、一体论必须向相对二分论“温和”转向。犯罪论体系应建构评价对象与评价标准相对二分的“一体四层”的体系。     

Age assessment by rib phase analysis in Turks

The I?can's phase method for the estimation of adult age at death from the sternal extremity of the fourth rib was introduced in 1983. Over the years, numerous tests have confirmed the reliability of this technique on varied samples. However, no large scale study has been conducted to test the application of this method on a modern white sample geographically, genetically, and culturally diverse from the American white database. Therefore, the purpose of this paper is to apply rib phase standards to a Turkish sample to test if the progression of morphological changes follow the same age sequence. Using a sample of 150 males and 144 females of known age at death, each rib was phased using the standards developed by I?can and associates in 1984 and 1985. The phase estimations were then subject to an analysis of variance. The results of the study indicated that Turkish ribs show the same morphological characteristics that define the phases at nearly identical ages. Variation as measured by the standard deviation increased from phase 5 on in both sexes. In conclusion, this study demonstrated that the rib phase standards can be accurately applied to Turks. Investigations of this nature are vital because one cannot assume that a method developed from one group is applicable to a distant population, especially in medicolegal proceedings.     

Two Simple Formulas for Evaluating the Lower Bound of the Impact Velocity in Vehicle–pedestrian Accidents

Formulas for evaluating the lower bound of the impact velocity are valuable in vehicle–pedestrian accident reconstruction. The theory of classical mechanics and four hypotheses were employed to derive formulas; the research results and simulation/accident tests were employed to validate their feasibility. Then, two simple formulas were developed according to the distance between the rest positions of the vehicle and the pedestrian and the flight‐phase distance. The results showed that the evaluated results by the two proposed formulas are inferior to the existing results. The influence of a roadside step on the impact velocity, which decreased with an increase in the flight‐phase distance and a reduction in the road slope, was evaluated. Based on a real accident, the study concludes that the lower bound can be easily obtained with the proposed formulas, which can be used to determine the evaluated impact velocity during simulations.     

交通伤后遗肾功能障碍的伤残评定

《道路交通事故受伤人员伤残评定》（GB18667-2002）有关交通伤致肾功能障碍的条款主要是针对一侧肾功能障碍,并将其分为轻度、中度、重度三个程度,以往常用的适用于肾功能评价的方法多已不适用。针对实践中出现的上述问题,结合临床放射性核素检测方法的进展,提出一侧肾功能障碍的程度可根据肾小球滤过率（GFR）的结果作如下分级：一侧肾功能轻度障碍（30 mL/min≤一侧肾脏GFR〈45 mL/min）,一侧肾功能中度障碍（10 mL/min≤一侧肾脏GFR〈30 mL/min）,一侧肾功能重度障碍（一侧肾脏GFR〈10mL/min）。     

Determination of age from the sternal rib in white females: a test of the phase method

Sex differences in both the rate and pattern of aging in the sternal extremity of the rib necessitated the development of separate standards of age determination for males and females. A test of the male phase technique has already demonstrated its reliability and soundness. The present study was carried out to evaluate the female phase standards. A sample of 10 test ribs including 2 control specimens, was judged by 28 volunteers representing several levels of education and experience in the forensic and anthropological sciences. As in the male test, the judges were asked to assign each unknown rib to an age phase by comparing it with photographs of prototype specimens from the original study. Analysis of the results revealed minimal interobserver error between the doctoral and predoctoral groups, and no discernible association between morphological variation in the rib and antemortem history. Furthermore, rib assignment for both groups of judges averaged well within 1 phase of the ideal phase in which the specimen would have been placed based solely on chronological age.     

Assessing Functional Impairment in ADHD: Concerns for Validity of Self-Report

Comprehensive diagnostic assessment of attention deficit hyperactivity disorder (ADHD) should include consideration of degree of impairment, and documentation of impairment is necessary to make service and accommodation determinations. While there has been increasing use of self-report as a way to document impairment, self-reported impairment could be just as vulnerable to invalid report as self-reported symptoms. We examined the influence of invalid self-report and invalid performance on report of functional impairment in a sample of 49 adults referred for evaluation for ADHD and/or learning disorder concerns. Overall, 26–59% of participants referred for evaluation endorsed at least moderate levels of impairment in the domains of understanding and communicating, household, and school/work. Individuals with evidence of invalid self-report of ADHD symptoms endorsed significantly higher levels of disability/impairment on the WHODAS, particularly in the domains of understanding and communicating, household, school/work, and participation in society. Further, individuals who failed a measure of performance validity reported significantly higher levels of impairment/disability, particularly in the domains of understanding and communicating, school/work, and participation in society. Results emphasize the need to assess for validity of self-report and performance in ADHD assessment. Since self-report of impairment may be suspect, clinicians should include data such as school records, past performance on high-stakes standardized testing, evidence of prior accommodations, and collateral reports before making diagnoses and/or recommendations regarding treatment or academic/workplace accommodations.     

《永久性残损评定指南（第六版）》基础概念评介

美国医学会第六版的《永久性残损评定指南》,代表了残损评定领域最新的、革命性进展。《永久性残损评定指南》旨在完善残损等级评定方法、提高评定的准确程度、增强评定结论的可信度,并使评定系数标准化,为残损评定提供稳定的、完备的方法。《永久性残损评定指南》最终目的在于,使利用该指南进行残损等级评定的结论具有权威性、公正性,并为评定所涉及的各方所认可。《永久性残损评定指南》的检查方法、术语以及分析架构以世界卫生组织的《国际功能、残疾和健康分类》为基础,涵盖了当今美国及国际社会最新有关残损等级评定研究成果,包括更为复杂、广泛的医学诊断手段,和更为准确功能丧失系数的解释说明等内容。所有的这些更新内容均有利于帮助鉴定人,在残损等级评定过程中消除争议,提高评定准确率。本文简要介绍了《永久性残损评定指南》第六版的基础概念,为我国法医临床学研究、借鉴《永久性残损评定指南》进行伤残评定提供依据。     

立法后评估：法律体系形成后的一项重要工作

中国特色社会主义法律体系基本形成,我国立法迎来从数量型发展向质量型发展的转折,立法后评估成为提高立法质量不可或缺的重要手段。本文以对重庆市地方性法规的评估研究报告为依据,阐述立法后评估的特点、主体、对象、内容、标准等一系列理论和实践问题,并就克服当前立法后评估遇到的制度困境提出了对策建议。     

中外法庭科学标准化研究现状比较与发展趋势

近年来,我国法庭科学发展迅猛,开始受到广泛关注和重视。经过多年的研究和推动,标准化正逐步深入到法庭科学的日常实践中,通过制定和实施标准规范,确保法庭科学结果质量,更好发挥科学技术在执法司法中的重要作用。标准化研究是法庭科学标准化工作的重要环节,也是推动法庭科学标准化发展的基础和动力。国内外法庭科学研究者都高度重视法庭科学标准化研究,许多新理念、新思想、新方法不断涌现。本文从标准定位、标准化对象、标准颗粒度、标准体系、质量控制、国际标准化六个方面对当前中外法庭科学标准化研究的现状进行了深入全面的归纳和比较,指出了国内外在法庭科学标准化研究方面的相似和差异,并对法庭科学标准化研究的未来发展趋势进行了分析,以求为推动我国法庭科学领域标准化工作高质量发展提供借鉴和参考。     

劳动能力鉴定中无晶体眼的视觉功能评价

无晶体眼视觉功能的评价是劳动能力鉴定中经常遇见的问题。准确评价无晶体眼的视觉功能障碍程度,有利于保证鉴定意见的科学性和客观性。无晶体眼不仅影响视力,亦可影响视野,引起视野缺损。单眼无晶体者较双眼视力对称性降低更易引起立体视锐度的损害。总结多年劳动能力鉴定中涉及视觉功能障碍评定的实践经验,可以紧紧把握劳动能力鉴定标准中＂依视力递减受损百分比进行比较＂这个关键,利用改进的＂对比相乘法＂对无晶体眼的视觉功能进行有效评价。     

论面向道路交通安全驾驶模拟系统研究

汽车驾驶模拟器在道路交通安全领域有着广泛的应用前景,面向道路交通安全的驾驶模拟系统是由驾驶舱等硬件系统和视景显示软件系统组成。其主要研究内容为视景仿真系统、动态驾驶模拟系统的开发研究,道路交通安全评价,事故分析鉴定与再现研究和道路交通环境的变化对驾驶行为的影响。